An alternative surgical approach to subclavian and innominate stenosis: a case series

Abstract

We report three cases of symptomatic stenosis of the great vessels or supra-aortic trunks successfully treated surgically with aorto-subclavian and aorto-innominate bypass. Two were performed via manubriotomy and a third case via standard median sternotomy because of concomitant coronary revascularisation. There was complete symptomatic relief on follow-up, and radiological imaging confirmed good flow in the grafts and post-stenotic arteries.

Aorto-left common carotid artery bypass with off-pump coronary artery bypass

“…Second, the aorto-supra aortic trunk bypass reportedly provides a more physiological blood flow pattern than cerebral approaches, such as a carotid-subclavian bypass. 6 Furthermore, in our patient, the ascending aorta and distal site of the left CCA were seen to be relatively healthy. Therefore, the side-bite clamping of the ascending aorta and clamping of the distal left CCA were considered to be a safe procedure.…”

Concomitant aorto-right subclavian artery bypass with off-pump coronary artery bypass grafting: a case report

“…Berguer et al [ 2 ] reported that, in comparison to the cervical approach, the transthoracic approach has a relatively higher morbidity but more durable results in atherosclerotic disease involving complex and multiple supra-aortic trunk vessels. Khalil et al [ 5 ] reported successful open surgery with a transthoracic approach in three patients using an aorto-subclavian or aorto-innominate artery bypass. Aorto-supra aortic trunk bypass is reportedly safe in patients with concomitant carotid disease with reduced cerebral risks, avoids endarterectomy and its attendant thrombotic risks, and provides a more physiological blood flow pattern than axillo-axillary or carotid-subclavian bypass [ 5 ].…”

“…Khalil et al [ 5 ] reported successful open surgery with a transthoracic approach in three patients using an aorto-subclavian or aorto-innominate artery bypass. Aorto-supra aortic trunk bypass is reportedly safe in patients with concomitant carotid disease with reduced cerebral risks, avoids endarterectomy and its attendant thrombotic risks, and provides a more physiological blood flow pattern than axillo-axillary or carotid-subclavian bypass [ 5 ]. In our patient, a direct ultrasonographic examination revealed severe atheromatous plaques inside the brachiocephalic trunk, and so we chose the right subclavian artery as the distal anastomosis site for the prosthetic bypass conduit.…”

Surgical treatment alternatives for occlusive disease of the subclavian artery based on our clinical experience

“…It should be noted that they excluded patients from their study with long stenoses (>4 cm) and those with complete occlusion of the subclavian artery, which can easily be corrected surgically. [19] The use of PTA for occlusive disease of the subclavian artery is increasing, but open surgical reconstruction remains an effective treatment option with good long-term results. [20,21] Kretschmer et al [9] found a statistically significant greater patency rate with transposition over bypass, and the universal experience in the small series of reported transpositions in the literature indicates that patency is almost always 100%.…”